This section has further explored some newer approaches to the management of acute lung failure in newborns and in adults. We have postulated that mechanical ventilation by and itself contributes to the evolution of ARDS. We have proposed a treatment approach whereby the pulmonary ventilation of patients with ARDS is reduced to but 2-4 breaths/min, with CO2 removed by an extracorporeal membrane lung. This results in rapid reduction in VA/Q mismatch, in prompt improvement in Pa02 an recovery from ARDS. Work in animal model has shown that lungs of preterm fetal lambs expand rapidly after intrapulmonary insufflation of the lungs, followed by apneic oxygenation. Extracorporeal removal of C02 with an efficient membrane lung is a powerful method to control ventilation in these premature newborns.